Hand surgeon David Friedman, MD, FACS, answers your questions about preparing for an upcoming hand surgery.
1. Will I need medical clearance before surgery? What other tests might I need?
Medical clearance may require a visit to your primary care physician and/or a specialist like a cardiologist or pulmonologist. Whether or not you require medical clearance depends on many factors including your age, medical history, and the type of surgery and anesthesia you are having. You may require blood work, an EKG, and/or a chest X-ray. For some types of surgery and depending upon your age and health status, no pre-operative clearance or testing may be needed.
Be sure to discuss all medications, including any blood-thinning medications you take with your surgeon, as he or she may request that they be stopped temporarily prior to surgery. Remember to include not only prescribed medications but over the counter medications and even vitamins and supplements. Be sure to mention everything!
2. What type of anesthesia will I receive?
The type of anesthesia you receive depends on several factors including the type of surgery you are having. Your surgeon will take into account the length and the complexity of your procedure, as well as your overall health, when determining what may be best for you.
Anesthetic options may include:
- Local anesthesia only: injected by your surgeon into the operative site to numb the area while you remain awake, similar to receiving numbing treatment at a dentist’s office.
- Combination of local anesthesia and sedation: you are asleep and don’t remember or feel pain, but you are breathing on your own. Some people call this “twilight” or “MAC,” and many patients have experienced this type of anesthesia during colonoscopies and other routine procedures.
- General anesthesia: you are completely asleep, under the care of an anesthesiologist, and may have a tube or other device to assist your breathing. This type of anesthesia is generally used for longer or more complex surgeries.
- Regional blocks: performed by either your surgeon or anesthesiologist. This type of anesthesia not only numbs the surgical site, as in local anesthesia, but numbs the entire hand or arm and can provide long lasting numbness for many hours after surgery. This type of anesthesia may be ideal for patients that are unable to undergo general anesthesia but require more than a local anesthetic.
You should discuss these options with your surgeon.
3. Will I need therapy after surgery?
Whether or not you will require formal hand therapy by a Certified Hand Therapist will be determined by your surgeon. Certified Hand Therapists are occupational or physical therapists who have completed extra training to focus on the intricacies of the hand. They not only understand the anatomy but the importance our hands play in our everyday lives; they target their therapies toward maximizing functional recovery quickly and safely. There is a specific window of opportunity during which hand therapy is most beneficial, depending on your surgery. If begun too soon, therapy can often hinder healing. However, if delayed, stiffness can set in and affect the outcome of the surgery. Not every patient requires hand therapy, and your surgeon will make that decision with you after surgery.
4. What can and can’t I do after surgery?
After surgery, you cannot drive or operate heavy machinery while taking narcotic pain medication or while wearing a splint or cast that hinders your mobility. This is typically 1-2 weeks after most procedures, but this timeline may be longer or shorter depending on the complexity of your surgery. Most surgeons encourage frequent walking after surgery to decrease the chances of forming blood clots in your legs, which can be very dangerous. Your clearance to return to work will be based on the type of surgery you had as well as the type of work you do. Your surgeon will help guide your safe return to these activities.
5. Will I be in pain after surgery?
Much of your post-operative pain will be from swelling, which should naturally decrease over the first few days to weeks. Pain from swelling generally tends to be worst during the 2nd and 3rd day after surgery. In order to minimize swelling and thus minimize pain, most surgeons recommend elevating the affected extremity on pillows or towels above the level of the heart as much as possible for the first week or as directed. Your surgeon may provide a specialized “arm elevator” to assist with this elevation.
It is important to follow your surgeon’s directions about moving parts of the arm or hand that are not immobilized. This can help prevent stiffness and reduce swelling. For instance, if you had surgery on your wrist, you may be encouraged to move your shoulder, elbow, and fingers freely.
6. Will I be wearing a splint or cast? How do I take care of it?
You may be put in a splint or cast that will immobilize your operative site. This may help to control pain.
Depending on directions from your surgeon, you may be able to shower carefully after surgery, but you must keep the surgical dressing and splint clean, dry, and intact. Cover the surgical dressing/splint with a water-proof bag while in the shower. An umbrella or newspaper bag may prove useful!
A few drops of blood on a surgical dressing may not be unusual, but if your dressing becomes saturated with blood after surgery, you should inform your surgeon immediately. If you experience increased pain, swelling, numbness or tingling, a fever > 101.5 degrees, or have any other concerns, call your surgeon, or report to the nearest Emergency Department for evaluation.
This blog post was written by hand surgeon David Friedman, MD, FACS, with assistance from Craig Forleiter, MD and Ketty Diaz, ARNP.
Dr. Friedman currently chairs the Department of Plastic Surgery and heads the Department of Hand and Upper Extremity Surgery at Cleveland Clinic Florida. Prior to joining the Cleveland Clinic, Dr. Friedman was on faculty at New York University Medical Center in New York and worked for nine years as the Director of Hand Surgery at Bellevue Hospital Center, the flagship hospital of the NYC Health and Hospitals Corporation. He also served as the Hand Surgery Fellowship Program Director during that time and volunteered as a Police Surgeon for the NYPD.
Trained as a General Surgeon and as a Board Certified Plastic Surgeon, Dr. Friedman also holds a Certificate of Added Qualifications in Surgery of the Hand. Dr. Friedman provides a multidisciplinary and comprehensive approach to patient care and works collaboratively with both the Department Plastic Surgery as well as Orthopaedic Surgery.